OT? Gait speed helps predict dementia

[WendyBG]

Changes in the brain that cause dementia can begin many years, even decades, before dementia is diagnosed. It’s useful to have indicators that predict future dementia so preparations can be made.

This large study shows that a combination of slower walking speed and loss of cognitive function together predict future dementia more than either separately.

https://www.medpagetoday.com/neurology/dementia/98989?xid=nl…

**Walking Speed Helps Predict Future Dementia**
**— Dual decline in gait speed and cognition tied to higher dementia risk**

**by Judy George, Senior Staff Writer, MedPage Today June 1, 2022**

**A combined drop in both walking speed and cognitive function was tied to an increased risk of dementia, a study of nearly 17,000 older adults showed.**

**Dual decline in gait speed and cognition carried a higher risk of dementia than either gait-only decline or cognitive-only decline. Dementia risk was highest in people who had slower gait speeds coupled with lower memory scores over time...**

**Compared with non-decliners, dementia incidence was highest in people who had declines in both gait and memory (HR 24.7), followed by gait and global cognition (HR 22.2), gait and verbal fluency (HR 4.7), and gait and processing speed (HR 4.3)....** [end quote]

What struck me was the extremely high Hazard Ratio (HR) which jumps up and bites you on the nose. It isn’t a subtle difference. People who have slower gait and poorer memory together are 25 times more likely to progress to dementia than normal controls.

The walking test is only 3 meters so it should be fast and easy for a doctor to perform. I can see that walking speed could be slower due to physical problems like knee arthritis or my ankle problem (Posterior Tibial Tendon Disorder) that slows people down, but a little common sense should prevail here. Barring specific physical problems, a recent exploratory study suggested Alzheimer’s and Lewy body disease have unique signatures of gait impairment that may reflect underlying pathology.

Until doctors become aware of this and start testing routinely, we should be alert to ourselves and our loved ones. Slower gait plus memory problems together are an early warning sign.

Wendy

[Leap1]

Wendy,

The biggest correlation is to suddenly missing sleep. In the older set there can be a major sudden decline.

Doctors do look for warning signs such as you mentioned. While not necessarily testing for dementia. It will still be up to family members and others to see this happening.

We as humans are built to live to an old age but when I see the thin, sober, warm older person I think of how precariously balanced physically and emotionally the person has been all their life. Of course that is my struggles with weight not theirs.

One of the simplest things I think anyone can do is to go to sleep with eye coverings. Block out the light in the room. Usually there is some. The sleeping is so much more valuable. There is a brand at Bed and Bath that bubbles up over the eye in shape for women that go to bed with false eyelashes. They do not press on the eyes as you try to go to sleep.

[VeeEnn]

Gait speed has been a marker for longevity and healthy living for a number of years (along with other aspects of the Senior Fitness Tests such as getting up off the floor no hands etc.) Here’s but one example from the older literature…a semi humorous piece from a few years ago…

https://www.bmj.com/content/343/bmj.d7679

I used an iteration of this for my Halloween SPIN classes in subsequent years.

Specific problem with assessing “normal” gait speed…especially in the physician’s office…is that anything that’s perceived as an assessment in anyone remotely compos mentis tends to provoke something akin to the Hawthorne Effect and participants tend to focus and try hard rather than adopt a natural, unconscious walking speed. There are tips and tricks that I’ve picked up in workshops geared towards training the senior client and I’m reasonably sure these are likely to be well utilized in, say, specialty geriatric centers but not so likely in the general internist/primary care setting.